Group therapy

Group therapy is a kind of psychological therapy that takes place with a group of people together rather than with an individual during a one-on-one session. While the term can technically be applied to any kind of psychotherapy that is delivered to a group, it is most commonly associated with a specific therapy type that makes use of the group dynamic.

Having therapy in a group environment can have many benefits as it offers a support network and provides the opportunity to meet others experiencing similar concerns. Together with the therapist and the other group members you should be encouraged to share your experiences and work on understanding yourself better.

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What is group therapy?

S.H Foulkes and Wilfred Bion pioneered group therapy in the UK by (independently) using the method as a way of treating combat fatigue during the Second World War. However, it was in America where group therapy was first used, after Joseph H. Pratt, Trigant Burrow and Paul Schilder founded the approach in the early 20th century. After the Second World War several psychotherapists including Irvin Yalom developed the concept further. In terms of modern group therapy and group analysis in the UK, it is S.H Foulkes' theory model that is considered the most influential.

Today, group therapy typically involves a small group of people (between seven and 12 is considered the norm) and a therapist. During the first therapy session, members of the group may start by introducing themselves and sharing why they are there. After this the therapist may encourage members to discuss their experiences and progress. The way in which a therapy session is structured will depend on the style of the therapist running the session and the nature of the concern(s) being explored.

The sessions are confidential, just as they would be in a one-to-one therapy session - and if you agree to attend group therapy, it is likely that you will be asked to commit to a certain number of sessions. Some sessions may involve discussion only, while others may involve group therapy activities. Such activities could include skill development, problem solving or trust building exercises.

If you do not want to talk or take part in the activities, you do not have to. For some people it takes a few weeks of sitting in and listening before they feel ready to talk about their own experience, so you should not feel pressured to do anything you don't want to do.

Group analysis

Group analysis is a specific method of group psychotherapy that was originated by S.H Foulkes in the 1940s. Within group analysis there is a key interest in the relationship between the individual and the rest of the group. Combining psychoanalytic insights and an understanding of interpersonal functioning, this approach aims to improve integration of the individual with their community, family and social network.

There are differences to be found between group analysis, group psychotherapy and groups that are therapeutic. The varying terminology however can be confusing, so we always recommend that you talk to your therapist about their approach before deciding on which route to take in terms of group therapy.

Aims of group therapy

In some respects group therapy and individual therapy are alike and the aims are usually similar. With group therapy however, the therapist may make use of the group dynamic to achieve these aims in a different way. Speaking in general terms, the aims of group therapy are:

1. To help individuals identify maladaptive behaviour

Being in a group setting in a therapy environment can help people identify their own behaviours and differences better. As there is room for comparison, you may discover that you are not perhaps as adaptive as you would like. Group therapy aims to help people see themselves and their behaviours more clearly.

2. To help with emotional difficulties through feedback

Discussing emotional difficulties with your therapist and other members of the group therapy session will provide you with extensive feedback. This feedback could be advice from the therapist or even practical tips from others in the group who have experienced a similar problem themselves. The aim is to help you learn your own coping methods so you can handle things if/when problems arise.

3. To offer a supportive environment

Group therapy is not only an opportunity to receive feedback and advice, it is also an opportunity to reach out and support others. What is discussed within your therapy sessions is done so in confidence. Speaking to people who are going through similar issues to yourself also helps you to feel less isolated and therefore more supported.

Yalom's therapeutic factors

As we have mentioned, Irvin Yalom was a key figure in the development of group therapy and his therapeutic factors are still adhered to by many therapists working with groups today. The following factors are some of those listed by Yalom and help to explain the theory behind group therapy in a little more detail.

Universality

This factor is about recognising that the shared experiences within the group may be universal - something experienced by humans around the world. Universality helps to raise self-esteem by removing your sense of isolation.

Altruism

When you are participating in a group therapy session you may find yourself able to offer help of advice to other members. This sense of altruism can help you develop your own interpersonal skills and adaptive coping styles.

Instillation of hope

Sometimes a group therapy session involves people at different stages of their recovery. This means you may find yourself in a setting with others who have been where you are and have found ways of coping and/or recovering; seeing this can offer hope during times of difficulty.

Imparting information

Being able to impart and swap information with others can be incredibly helpful. Many members of group therapy have stated that they found it helpful to learn more about other members, this could include information about their treatment or access to services.

Development of socialising techniques

Speaking in a group therapy session allows you to improve social skills and interpersonal behaviour in a safe and supportive environment. This can help to build confidence and you can put such skills into practice outside of the therapy sessions.

Imitative behaviour

In some instances being in the same environment as a therapist and even other recovered members of the group can help you develop skills through observation and imitation. You get the chance to see how others react and problem solve, offering you the chance to learn through their positive behaviour.

Cohesiveness

Humans are herd animals by nature and for most of us being a part of a cohesive group offers a sense of belonging, acceptance and validation. Working through issues in a group setting can therefore feel very comforting.

Existential factors

Speaking to others about their experiences can help you learn about responsibility and the consequences of your decisions. Sometimes hearing about mistakes other people make can help to give you perspective.

Catharsis

Catharsis refers to the experience of relief from emotional distress via uninhibited expression of emotion. Telling your story to a group of supportive and understanding people can be incredibly cathartic and may offer relief from feelings you had previously repressed.

Interpersonal learning

Interacting with others who provide feedback on your behaviour and the impact it has can help you achieve a greater sense of self-awareness. Understanding your behaviours better is often the first step to change and recovery.

What can group therapy help with?

While group therapy can technically be applied to a variety of approaches and a variety of concerns, there are certain areas that may particularly benefit from a group dynamic. The following topics are examples:

Having a strong support network is key when it comes to overcoming addiction. For some people, this kind of network isn't available at home and they may benefit more from the support of others with an addiction. Hearing how others cope, learning interpersonal skills and uncovering how your behaviours can impact other people can all help you on your journey to overcoming addiction.

For people suffering with anxiety, getting out and interacting with those who understand can be helpful. Knowing you aren't alone in your feelings and hearing how others manage their anxiety can be invaluable. You are also likely to develop better social skills, which can help if you suffer from social anxiety.

Those dealing with depression may find themselves feeling vulnerable and isolated. Getting out of the house and talking to others is always useful and in a group therapy session it can be even more so. Reaching out to others going through similar issues and discussing coping mechanisms can help you to help yourself. You may also find that imparting your own advice helps to boost your sense of self-esteem.

For some people, the support network created by group therapy can aid recovery from an eating disorder. For others however, it can be counter productive. If you find that you are comparing yourself to others in the group (for example their weight/size) it may be worth seeking individual therapy instead.

Being alone with your own thoughts during times of anxiety can trigger symptoms when you suffer from obsessive compulsive disorder. Speaking to others who understand your feelings and behaviours can help you understand your condition better. Together you can support one another and look to find ways of coping.

If you find it difficult to forge and maintain relationships, attending group therapy could help. Being around other people on a regular basis can help you to develop interpersonal and social skills that you can go on to practice outside of your sessions.

Group therapy for those with schizophrenia can be beneficial, depending on the severity of the condition. It can be helpful to reach out to others who experience similar symptoms to yourself, and learning more about the disorder can help you understand your own thoughts better. If you find you are feeling unsafe or paranoid during group therapy sessions however, it is important to discuss your feelings with your therapist.

Meeting with others who struggle with self-harm can help you feel less alone. Hearing how others cope with their problems, including practical tips you may not have thought of, can also be incredibly helpful.

Group therapy activities

Some therapists like to incorporate group therapy activities into their sessions. The purposes and types of these activities used will depend on the nature of the concerns being explored and are often tailored to suit the needs of the members.

The following activities are popular in group therapy:

Icebreakers

Icebreakers are activities that help members of the group get to know each other and to feel more comfortable. In some cases this simply involves going around the circle, introducing yourself and explaining why you are attending group therapy. Some therapists will introduce games and activities to help you feel relaxed and to introduce alternative ways of thinking.

Example activity: The game 'categories' requires you and other members of the group to organise yourselves into small groups according to certain categories such as favourite colours, hobbies, month of birth etc.

Trust building activities

These types of activities are designed to help you develop mutual respect, empathy and understanding. These can be particularly helpful if you find it hard to form relationships or have difficulty trusting others.

Example activity: In the game 'mine field' objects are scattered on the floor and, working in pairs, you have to guide your teammate around the objects blindfolded. You then swap and your teammate guides you, attempting not to step on the objects.

Psychological exercises for insight and self-awareness

Exercises of this kind are designed to help you think in different ways and understand why you, and others, think or behave a certain way.

Example activity: 'Mirror image' requires you to work in pairs and involves one of you mirroring the other's movements.

Support groups and self-help groups

Group therapy is facilitated by a professional therapist who monitors the behaviour and progress of the members. In contrast to this, support groups and self-help groups may not involve a therapist. Typically support groups are made up of people who are experiencing the same issue or concern and meet up to provide each other with emotional support. Group therapy activities may not be involved and the focus is usually on discussion and providing empathy.

Self-help groups normally involve the exchange of information and advice regarding the concern in question. You may discuss outside resources or you may simply discuss your own experiences. Support groups and self-help groups can be particularly helpful for issues such as bereavement or terminal illness. If you think you require the kind of therapy that could help you change your thoughts or behaviours, you may benefit from a group therapy session instead.

Seeking support from others can be invaluable when you are having emotional difficulties and it is important to find an approach that works for you. Speaking to a professional such as your doctor or a counsellor can help you decide if you would benefit from group therapy or support/self-help groups.